As of Thursday, May 2, 2013
DEAR DOCTOR K: I’m scheduled to have a corneal transplant. What can I expect during this procedure?
DEAR READER: The cornea is the clear, round “window” that allows light to enter the front of the eye. If the cornea becomes severely diseased or damaged, it can cause a significant loss of vision. A corneal transplant often is the best solution. In this procedure, an eye surgeon replaces part of the cornea with a section of healthy cornea taken from a deceased donor. Donor corneas come from a local eye bank.
Before surgery, your doctor may prescribe antibiotic eye drops. You may need to adjust or discontinue certain medications that could increase your risk of surgical complications. In the meantime, the eye bank will confirm that the donor cornea is free of infection, transparent and structurally sound.
The eye surgeon will measure your eye to determine the size of the cornea that is needed. Before the surgery is started, the surgeon will cut the donor cornea to the right size.
Corneal transplants are usually done as an outpatient procedure. You will get a sedative and local anesthesia. You’ll be awake but drowsy; you’ll feel tugging on your eye but will feel no pain. The surgical team will use special techniques to keep your eyes open so you don’t have to worry about blinking.
The surgeon will cut out a circular “button” of tissue containing the diseased or damaged part of your cornea. Then the donor cornea will be stitched into place using fine nylon sutures (surgical threads). (I’ve put an illustration of the procedure on my website, AskDoctorK.com.) Afterward, your eye will be covered with a soft eye patch and hard eye shield.
Steroid eye drops will help prevent your body from rejecting the transplanted tissue. Rejection is the most common complication: The body’s immune system identifies the donor cornea as foreign and begins to attack it. In most cases, rejection can be treated successfully with medication.
You’ll continue to wear the eye patch for a few days. Sutures are usually left in place for several months, or they may be allowed to remain in the eye permanently. After the transplant, your vision should improve gradually over a period of months.
Corneal transplant surgery was first performed more than 100 years ago. Over the years, the results have become much better. Superior surgical equipment now is available, and the risks of infection are much lower because of antibiotics. The risk that the transplanted cornea will be rejected has been greatly reduced by medicines that suppress the immune system in the eye.
Even 60 years ago, people with damaged corneas could not always be saved from blindness. Today, the odds are very good that their vision can be restored.
Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.